Precertification Specialist-Hematology/Oncology (Remote) - UAB Medicine - Birmingham, AL
(2023-01)
- Responsible for gathering adequate and necessary information from the referring physician to obtain authorization prior to patient scheduling of CT, MRI, or PET scans based on requirements of the insurance carrier
- Coordinate and conduct pre-admission reviews for all scheduled and urgent patients
- Determine appropriate level of care based upon clinical review, medical necessity criteria and institutional patient placement guidelines
- Complete all aspects of the pre-certification process and negotiate the appropriate level of services within required time frames.
- Utilize preliminary codes to identify procedures requiring outpatient status or insurance authorizations to assure timely and accurate reimbursement.
- Extract pertinent clinical information from the electronic health records and provide to payers utilizing payer specific communication protocols.
- Document all actions, contacts, outcomes and interventions to assure appropriate payment of claims and assist with potential appeals.
Operations Assistant/Medical Records - Naphcare, Inc. - Vestavia, AL
(2014-01 - 2016-12)
- Requested medical records from providers to ensure continuum of care, payment of claims, and verification of services
- Assisted medical staff and other personnel with proper medical reports
- Collaborated with health information management departments of the providers to ensure timely response to medical record request
- Utilized healthcare experience to consistently schedule appointments that meet internal protocol and production standards
- Liaison between medical records, scheduling and claims department
- Maintained confidentiality when managing medical records, patient data and processes
- Demonstrated skills in accuracy and multitasking while working to impact progress within the daily workload and adhere to internal deadlines.
